X-ray apparatus comprising an x-ray source fixed in the floor of an examination room



Feb. 11, 1964 J. R. LATSON 3, 1, 7

' X-RAY APPARATUS COMPRISING AN X-RAY SOURCE FIXED IN THE FLOOR OF AN EXAMINATION ROOM Filed Jan. 31, 1961 6 Sheets-Sheet 1 JOSEPH R. LATSON INVENTOR.

ATTORNEY Feb. 11, 1964 J. R. LATSON 3, 21, 67

X-RAY APPARATUS COMPRISING AN X-RAY SOURCE FIXED IN THE FLOOR OF AN EXAMINATION ROOM Filed Jan. 31, 1961 6 Sheets-Sheet 2 JOSEPH R. LATSON INVENTOR.

AT TOR NEY Feb. 11, 1964 J. R. LATSON X-RAY APPARATUS COMPRISING AN X-RAY SOURCE FIXED IN THE FLOOR OF AN EXAMINATION ROOM 6 Sheets-Sheet 3 Filed Jan. 31, 1961 JOSEPH R. LATSON 1 N VEN TOR.

f ATTORNEY Feb. 11, 1964 J. R. LATSON 3,121,167

X-RAY APPARATUS COMPRISING AN X-RAY SOURCE FIXED IN THE FLOOR OF ANEXAMINATION ROOM Filed Jan. 31, 1961 6 Sheets-Sheet 4 65 194 ms 196 I: I G I I JOSEPH R LATSON INVENTOR.

A TTORNEY I97 BY Feb. 11, 1964 J. R. X-RAY APPARATUS COMPR IN THE FLOOR 0 Filed Jan. 31, 1961 LATSON 3,121,167 ISING AN X-RAY SOURCE FIXED F AN EXAMINATION ROOM 6 Sheets-Sheet 5 JOSE PH R.

L ATSON INVENTOR.

ATTORNEY Feb. 11, 1964 J. R. LATSON 3,121,

X-RAY APPARATUS COMPRISING AN X-RAY SOURCE FIXED IN THE FLOOR OF AN EXAMINATION ROOM Filed Jan. 31, 1961 6 Sheets-Sheet 6 JOSEPH R. LATSON INVENTOR.

ATTORNEY United States Patent 3,121,167 X=RAY APPARATUS CGMPRISING AN X-RAY SGURCE FIXED IN THE FLGOR (3F AN EXAMINATION RQGM Joseph Robert Latson, 2927 University, Houston, Tex. Filed Jan. 31, 1961, Ser. No. 86,048 7 Claims. (1. 250-91) This invention is directed to an X-ray assembly for use in diagnosis and in operative diagnostic procedures. It is especially adapted to facilitate and improve cardiac catheterization and cineangiocardiography. The assembly, also, avoids any requirement of movement of the patients position with regard to the table on which he lies during X-ray examination of that patient, provides X-ray pictures of diagnostic quality, and facilitates operator access to the patient undergoing examination and treatment.

Cardiac catheterization laboratories have heretofore employed available radiographic machines intended for conventional radiographic studies. These devices, however, do not fulfill all the needs of present and future catheterization techniques for diagnosing and treating complex malformations of the heart.

Thus, existing assemblies used for cardiac catheterization and cineangiocardiography, even including image intensifiers, are still attachments to conventional radiographic machines with inadequate protection to operators and assistants, short tube-to-patient distances with consequent image distortion and inaccuracies, obstructions by supports at points around the table to the motion of the physician or surgeon in regard to a patient, frequent obstructions below the table limiting the motion of the X-ray apparatus with respect to the patient, inadequate provision for flexible use of measuring instruments for attachment to the patient, and inherently require turning of the patient for lateral examination, unless two separate image intensifiers are employed.

Accordingly, I have made a device which allows the following: (l) complete access to the patient by the operator or operators at any part of the operating table, and an anesthesiologist, if needed, (2) posteroanterior, oblique, or lateral fiuoroscopy, spot films, or cineangiocardiography without changing the patients position relative to the table, (3) antero-posterior or lateral, or biplane angiocardiography in conjunction with fiuoroscopy without moving the patients position relative to the table, and (4) ease of operation, maximum use of allowable room space, and unlimited, theoretically, tube-to-patient distance.

According to this invention, there is provided a diagnostic and operating X-ray assembly which provides an operating and diagnostic field which is free of obstructions required for support of the associated X-ray machine. Accordingly, the physicians are provided with access to the patient from all sides of the patient, and further, may also m ve the patient, on the operating table, about freely, in order to keep in X-ray view any part of the patient, all wid'iout obstruction or limitation because of the X-ray machine. Further, because of the long tube-to-screen distance and use of X-rays that pass through the patient all substantially parallel, and shielding, there is a minimum exposure of the surgeon and other operators to X-ray by direct rays or scattering as occurs by less parallel rays, as well as maximum sharpness and diagnostic qualtity of the X-ray pictures and image obtained.

One object of my invention is, therefore, to provide an X-ray assembly in combination with a support for a patient that provides long distances from X-ray tube to the phosphorescent screen or viewer therefor, X-r-ay picice tures of diagnostic quality, and require no motion of the patient with respect to his support.

A further object of this invention is to provide an X-ray tube assembly support and patient support that permit access of the operator or surgeon to the patient from all sides.

Yet a further object of this invention is to provide an X-ray support assembly and examination table that permits precise X-ray examination of all parts of the patients body on said table without movement of said patient with respect to said table.

Still a further object of this invention is to provide an X-ray diagnosis table for use in the above-described assembly that permits movement of X-ray apparatus above and below the top surface of said table and is provided with supports for electronic plugs that are interconnected Without obstruction across the surface of said table.

A further object is to provide an X-ray assembly that permits one image amplifier to be used with either of two X-ray tubes, said X-ray tubes being arranged to have their axes at right angles to each other.

Generally, other objects and advantages will become apparent from the following description taken in connection with the accompanying drawings, in which:

FIGURE 1 is an overall side view of an assembly embodying my invention;

FIGURE 2 is a perspective overall view of the assembly of FIGURE 1 and including the second X-ray tube in position for lateral angiocardiography or fluoroscopy;

FIGURE 4 is an enlarged view of the image amplifier carrier as seen in direction of arrow 4 of FIGURE 1;

FIGURE 3 is an enlarged view of portion of the hydraulic cylinder shown within dotted area 3 of FIGURE 1, partly broken away to show some detail thereof;

FIGURE 5 is a view of the carrier assembly as seen along the direction of arrow 5 of FIGURE 2 with the image intensifier tilted;

FiGURE 6 is a side view of the mounting for the side X-ray tube;

FIGURE 7 is a plan view of an operating room con taining the assemblies of this invention;

FIGURE 8 is an overall schematic representation of the hydraulic fluid tubing connections with some details shown; and

FIGURE 9 is an enlarged sectional view of the table 21 taken along line 9-9-" of FIGURE 1.

Generally, this invention comprises a cooperative combination of an X-ray tube 15, in a horizontal floor 16, at a substantial vertical distance (some-4 feet) from the body of the patient 17 to be examined, a collimating shield 19', reaching from the tube up to the top surface of table 21, which surface is substantially transparent to X-rays, a screen (located at 22) or, preferably, an image intensifier tube 23, which are firmly, yet rotatably and pivotally, supported by the carrier 25; and a second X-ray tube movable in a plane perpendicular to the horizontal which second X-ray tube may be used with the same image intensifier 23, or screen 22, or a rapid film changing cassette.

The X-ray tube 15 is mounted in a lead-lined shielded well 26 beneath the horizontal floor 16. This is preferably at a distance of at least 48 inches below the top surface Ztl of the table 21. The well is about 3 feet deep in the preferred embodiment and made of steel and firmly positioned and supported on floor beams or piers, as 153. Extra length 138 of the flexible conduit cable 137 loosely stores and makes electrical connection within the well so that when the table is moved, the stored extra length 138 of such connected conduit needed is readily 3 available .to permit free movement of the table about the operating room.

This substantial tube-to-patient distance accomplishes several beneficial results. Firstly, there is a significant decrease in the image size distortion concomitant on the usual short tube-to-patient distances used in cineangiography. Accordingly, by the device of this invention, not only can the relative'positions of anatomical structures and their sizes in the horizontal patient be more precisely measured than heretofore, but, also, the scattering, penumbra efiect and consequent blurring of the X-ray or fiuoroscope image or picture concomitant on using X-rays at substantial angles to the plane examined is reduced. Accordingly, relative to the results heretofore obtained, the diagnostic quality and utility of the picture obtained by use of the assembly of this invention are greatly improved. Secondly, the large tube-to-patient distance has the advantage of allowing the use of a relatively large focal spot (of 1 mm.) in the roentgen tube and so does not require the use of the more expensive fractional focal spot roentgen tubes.

The collimating tube in the preferred embodiment has an internal diameter of 9 /2 inches and is lined with a /s inch thickness lead.

The uppermost part of the collimator, collar 27, is adjustably extendable to within inch (the thickness of Lucite slab 12d) of the patient. collimation of the X- ray fields from the roentgen tubes, as provided by lead lined collimator 19, not only reduces the variation of angle of rays penetrating the patient but, also, protects the operator beneath the table.

Adequate ventilation of the space in the collimator is provided :for by bafiies. Cooling of the X-ray tube is accomplished by conventional ambient air cooling thereabout.

The internal diameter of the collimator 19 is the diameter of the largest desired field of X-rays which are needed.

The table 21 is provided with one large slot 29 on its left side and a similar slot 3% on the right side, and a central slot 31 within and adjacent the table top and clear of obstructions. These slots are all of greater width than the outside diameter of the collimator and angiocardiographic film cassette, not only so that the entire table may be moved readily back and forth and sidewise while providing a minimum distance between the collimator and the patient, but also so that all parts of the patients body may be exposed to X-rays all passing substantially normal to the top surface of the table, and so that the table may be moved over a film changer or cassette for use in conventional angiocardiography in conjunction with the second X-ray tube (50, FIGURE 2) in either anteroposterior or lateral projections.

A cylindrical image amplifier 23 is, in the preferred embodiment, attached to and positioned over the patient. This image amplifier is rigidly supported on pivot rod or shaft 3'2, at the bottom of carrier rack 25, as below described in detail. The pivot rod or shaft 32 pivots in bearing surfaces 35 and 36 provided in carrier 25. Pivot rod 32 is located, in the disposition of elements shown in FIGURE 1, at the bottom of tube 23 and items attached thereto; the central longitudinal axis of rod 32 intersects the central longitudinal axis of the X-ray shield 19.

Carrier 25 is firmly attached to the bottom of a movable cylindrical piston 39 positioned in a fixed hydraulic cylinder indicated generally as 40. Piston 39 is readily rotatable therein, as below described. The longitudinal axis of piston 39 is, in FIG. 1 colinear with the longitudinal axis of tube 23. Thus carrier 25 and tube 23 may readily be rotated into any position 360 degrees around the vertical axis of the image amplifier tube 23, as shown in FIGURE 1. The diagnostic and operating field may thereby beviewed from any position with respect to the patient. The cylinder 40 is rigidly fastened to the building frame structure 41, which supports the ceiling :2. Threeway valve 24 controls the motion of the carrier 25, as below described. A second hydraulic cylinder 44 operating, through piston 105, on pivot arm 45 tilts the entire image amplifier system comprising the amplifier tube 23 with its mirror system '46, camera 47', and television portion 48 about the pivot 32 from the vertical position of FIGURE 1 to the horizontal position of FIGURE 2 or to any position therebetween. Three-way valve 49 controls cylinder 44; thereby this portion of the apparatus (items 23, 46, $7 and 48), which is quite expensive, may be used also with a second X-ray tube, as 56, for lateral and oblique studies of the patient without turning the patient. This method of support of the image amplifier below discussed in detail, minimizes any oscillation of the image picture provided by the X-ray apparatus.

This carrier system provides the rigidity and stability needed to obtain fluoroscopic visualization and moving pictures of diagnostic quality. The frame for the carrier is controlled hydraulically as below described. The diagnostic quality of the X-ray or fiuoroscope picture or image is thus maintained notwithstanding the large tube-to-screen distance and motion of the patient permitted relative thereto because of the sturdy stable mounting provided for the tube and its screen and/or irnage amplifier. Because the connection between piston 39 and tube 4% is so firm as to resist axial hydraulic forces of several hundred pounds per square inch, the moving piston 39 is not only held to that fixed element extremely firmly, but also such connection between such elements acts as a damping mechanism to prevent vibration therebetween. This arrangement minimizes vibration of the screen and permits clear moving pictures, presently taken at 16 to 64 frames per second, to be conveniently and clearly made at any time during an examination.

The second roentgen tube 5% is separately suspended on an extensible arm 51 of hydraulic cylinder 52. This cylinder is supported on pivot support 53. Another hydraulic cylinder 55, operating through a rigid link 56 which rotates about a pivot pin 54 in pivot support 53, controls the position of cylinder 52. Three-way hydraulic valve 57 controls cylinder 52; a three-way hydraulic valve 59 controls cylinder 55: the support 69 for cylinder 55 is fastened to vertical bracket 61. Pivot support 53 is supported on horizontal bracket 62. These brackets are firmly supported in the ceiling via frame 1&3 and 161 to the building frame structure 166. The longitudinal axis of cylinder 52 is constrained by the pin linkage 56 and pivot pin 54 in pivot support 53 to rotate in a vertical plane which includes the longitudinal axis of tube 23. Three-way control valves 57 and 59 are supported on wall 64. Clamp 151 on cylinder 52 also may fix arm 51. All hydraulic cylinders are provided as in FIGURES 1, 4, 6, and 8 with positively locking balanced valves so that the hydraulic pressure pump does not need to continuously run in order to hold any desired position of the pistons in the hydraulic cylinders. Each of these cylinders thus only allow movement of the piston associated with each such cylinder against gravity on application of at least a predetermined minimum pressure thereto. Additionally, solenoid control 66 is provided on the hydraulic cylinder 40 which supports the image amplifier. This solenoid provides positive patient protection by means of microswitch contacts that do not allow the image amplifier to actually exert any force on the patient, by immediately reversing the direction of motion of the piston 39 upon contact of the microswitch 67 (described in detail below), withthe patient 17. Also, all safety balance valves, as 76, 71, 72, 73, are mounted directly on their respective cylinders (40', 44, 52, 55, respectively) so that if a hydraulic line to any such cylinder is broken from any cause or pressure fails, the balance valves will not allow gravity to expel the contents of the cylinder or change its position.

The hydraulic valves 24, 49, 57, 59, described are spring loaded to return to center, which is a no-flow position; in order for flow to occur one direction or another the valves must be pushed against the spring. The valve solenoids 74 and 75 must be actuated continuously to permit flow in one direction or the other. The solenoid actuated valve is used in the large rack so that a microswitch may be employed in the safety device. The microswitches activate up position solenoid 74 and, as by solenoid 66, deactivate the down position solenoid 75 for the rack 25 so that if that rack or the tube supported thereby touches any object below it, it would immediately begin to rise until it is above that object.

The above described rigidity of the support carrier 25 is obtained by that, in the preferred embodiment using a 1 foot inch diameter tube 23, of 1 foot inches length and a television camera thereabove, the carrier comprises a U-shaped stainless steel element 79, 3 feet Wide and inch x 2 inch size supported on an upper steel plate 85 of 2 feet diameter and /2 inch thickness; /2 inch outside diameter and 2 feet 0 inch long stainless steel bars 81, 82, S3 connect from plate 3%? to one vertical arm 35 (3 feet 11 inches long) of the element 79, while 2 feet 0 inch long bars 86, 87, and 83 support vertical arm 94? of element 79. Further to mate rigid the vertical arms, a /8" x 1 /2" strip 91 is Welded to arm 35 along its length, at ten inch intervals. According to one improvement included within the scope of this invention arms 85 and 90 would be 2 inch by 2 inch outside dimension squares inch thick. The hydraulic tubing and wire would pass through these heavy hollow support members, and the switch, as 43, would also be housed within such arm.

Pivot rod 32 is 1% inch diameter stainless steel and is attached to the tube 23 by a 2 inch wide inch thick stainless steel band 9'2 which closely fits the taper /2 inch in 1 foot) of the outside of tube 23; band 92 is attached by inch x 2 inch stainl ss steel arms 93 and 95 to bolts, as 96, which firmly support the image tube, 23, and the television camera 47 thereabove. This camera and image tube with mirror system 4-6 have a total weight of 500 pounds and a center of gravity 12 inches from the longitudinal axis of pivot shaft 32. The piston rings 13? and 14%) provide a firm seal between piston 39 and cylinder 40 to contain upward pressure of the hydraulic fluid 14-1, and prevent flow of fluid thereby. Rings 142 and 143 make a similar seal against leakage of fluid therepast when pressure (required to pass the balance valve) is applied from above.

The arm 96 is bent at 97 and 99 to provide, in combination with a supplementary x 2" stainless steel bar 1%, which bar 194 is joined to arm 9i and pivot shaft or rod 32, to provide a 4 /2 inch Wide (interior width) yoke supporting one portion -1 of pivot shaft 32. Collars 109, 119, 111, 112 are provided on either of the arms of the yoke for stability. A bracket N52 is firmly attached, as by welding, to the portion 193 of bar 98. Hydraulic cylinder 44 has a 4 inch inside diameter; subtracting the cross-sectional area of arm ltld leaves an effective cross sectional area of 12.8 square inches. The center to center distance of pin 1% from rod 32 along link 45 is 3% inches and the angle of said (pin) center to (said rod) center line of link 45' to the horizontal varies from =+35 in the arrangement of apparatus shown in FIGURE 1 to -55 in the disposition of apparatus shown in FIGURE 5.

The pressure in the hydraulic system is maintained, in the preferred embodiment, at 360 p.s.i.g.: the pressure manifold 181 is protected by a one-way valve 182 against loss of the pressure, indicated by pressure gauge 183. The pressure is developed by pump 65 operating on fluid from reservoir 186. Exhaust manifold 185 also feeds into reservoir $.86. Pump 187 drives motor 65.

Thus the torque developed by the second piston 44 and its arm 45 is adequate for reliable and convenient control of motion of the carrier assembly: the pressure used in the cylinder and the size of the hydraulic cylinder will be, of course, changed to accommodate greater torques as needed. The tubing used, as herein described for the preferred embodiment, is designed to handle hydraulic fluid at 300 p.s.i. The hydraulic overload 198 is set at 300 p.s.i. Larger pressures can be used as needed on the particular embodiment herein disclosed.

:Safety valves 169, 170, 172, 174 in combination with one-way valves 16%, 171, 173, and 175 respectively maintain such (300 p.s.i.) pressure in the cylinders as needed for safety and stability as hereinabove described.

The microswitch 67 comprises a Lucite plate .145. The Lucite plate is supported by four nuts which are slidably supported in the carrier 25; those bolts serve to actuate microswitches 147 and 148 on contact of the Lucite plate with a solid body therebelow. Each such microswitch, as 147, acts to energize solenoid 6d and so deacti vate down switch as well as actuate up solenoid 7 of valve 24 when the plate 146 is urged upwardly on its slidable supports relative to rack 25, as by contact of said plate with a patients body during downward movement of the rack. This assembly has such a sensitivity that an eggshell is not destroyed by downward contact of the carrier assembly and the components attaohed thereto when such egg is caught between the Lucite plate 146 and the top 26) of the table 21.

X-ray tube St), a conventional type, weighs about 50 pounds: it is provi ed with a variable field illuminated collimator 15%; it is supported on solid steel piston arm 51. Arm 5]. has a 1 /21 inch outside diameter in the preferred embodiment and fits into cylinder 52 in the same manner as does piston 3%? in cylinder 4%). Cylinder 52 in the preferred embodiment has a 3 inch interior diameter, provides for a 6 inch blocked length for arm 51 and provides for a 48 inch maximum extension of arm 51. Pivot pin 54 is solid steel, 1 inch diameter, and is firmly sup ported on the U-shaped pivot support 53 formed of /2 inch thick steel. Link 56 is cold rolled steel. Piston 55 has a 4 inch internal diameter and provides for a 12 inch travel of the cievis 58 and its pin.

The bracket 61 is formed of a vertical 8 inch I-beam, extending from a height of 40" from the floor up to the false ceiling 42. It does not rest on the floor so that the floor space may be utilized below it. The top of bracket 61 is welded on one side to a similar horizontal I-beam 62 at the ceiling level. Both brackets are firmly supported by the framework of the building: in hospitals these frames are usually made of heavy structural reinforced steel or concrete. Steel I-beams 162 and 164 connect l-beams 151 and 163 respectively to building frame girder 166. Horizontal I-beam 161 is attached, as by bolts, to horizontal I-beam 168A which is welded to beam 61; I-beam 163 may be similarly bolted to bracket 62. Thereby the brackets 61 and 62 are firmly supported in the building frame and provide positive support and determination, of the axis of rotation of arm 52.

The hydraulic connections are made as shown in FIG- URE 8 with 3,600 p.s.i. test flexible tubing. The cylinder 4-6 in the preferred embodiment has a 4 inch inside diameter; the piston rod 39 therein has 21 1 inch outside diameter. This hydraulic system has a 20 inch maximum extension and the tube ill has a 2 feet 6 inch length. The tube 40 is located almost entirely Within the false ceiling 42. Steel angles 2 X 2 x inch thick, as 177, supported on bolts, as 178, in girders, as 41, of the building frame, support a heavy /2 inch thick) steel plate 179, which plate, in turn, is bolted to and supports hydraulic cylinder 40. The horizontal steel base 158 of hydraulic cylinder 40 is upturned to form a vertical lip 159; the bases of one end of each of the 2" x 2' x steel channel members of which struts 156 and 157 are formed are firmly fastened, as by welding, to lip 159. The other end of each such base of each such strut, as 156, is similarly firmly fastened to a channel member, as 177. These channels act as struts and are positioned at about 45 to the horizontal and 90 to each other. Thereby the cylinder at and rack 25 are firmly supported by the building frame and their central longitudinal axis firmly positioned wtih respect to such frame.

X-ray tube 15 is firmly supported and positioned on seat 114, which seat is bolted or otherwise firmly supported and positioned in well 26 which, as above described, is also firmly supported by the building frame structure.

A plate 113 is provided on arm 85 which plate has inch diameter holes 115 therein in which a T-pin 116, inch diameter, stainless steel, held in clevis holes 117 and 119, is removably positioned in order to hold the assembly in position independently of the hydraulic system above described.

The table 21 is 6 /2 feet overall length, 2 /2 feet overall Width, 2 feet 9 inches high. Its top is formed or" a inch thick Lucite (methyl methacrylate) sheet 12% and chan nels 121. The charnels are made of Ls, 122, 123, 124- as shown in FIGURE 9. These Ls may be welded. The legs 125, 126, 11.27, and 123 are made of 1% inch diameter 16 guage tubing as are the cross rails 13%. Tie table is mounted on precision two-way lock casters as 131 whereby the table and the patient thereon are moved easily between the roentgen tube and the ima e amplifier or fixed by locking. This table is designed so that any type of available electronic instrumentation may be connected directly to the table on any side as illustrated at vertical panel 132 with various plug outlets as 135 therein. The plug heads are thus spaced around the sides and the ends of the table and intercommunicate along the inside of the periphery of the table, as shown in FIGURE 9; the Portion of each plug projecting from the interior of each panel is mechanically protected as from the collimating shield 19 and collar 27 by the spacing bars, as 136 and 136', of each panel, as 132 and 134, respectively. The plugs are interconnected and connected with the conduit 137 by wires that stay within the thickness provided by such bars for each of the panels as 132 and 134. Conduit 137 comprises twelve six-wire cables, and therefore, permits twelve control instruments to be connected to the patient. Accordingly, no hoses, cords, wires or the like are required to pass under or over the table. This substantially facilitates the operating technique of those who use X-rays with other equipment as diagnostic and operating instruments. As no wires cross over the top or under the table, the table may be moved freely with respect to the collimator l9 and screen 22. Accordingly, any part of the patients body on sheet 12% is available for access and study. Thus, any extremity on part of the patient is readily available to one or more operators at the same time and techniques ut lizing two or more catheters simultaneously from difien ent points of insertion are greatly facilitated.

An electrocardiograph is a frequent tool used concurrently with the other electrical devices in cardiac catheterization. Accordingly, it is important to minimize the number of hose and tube connections going over the table to leave a clear field for the observation as well as manipulation of the patient. The elimination of long draping cables from passing over the table has a substantial advantage which is achieved only by the use of the side panels as 132, 133, 134 with there being a large enough hole for the shield 19 to pass therethrough as provided for by the apparatus of this invention. This, also, keeps the table clear for the effective use of the side X-ray tube Ell.

In the usual cardiac catheterization procedure, a catheter is injected into a large vein of the patient, as the right saphenous vein, in the supine patient on the table 21. In these circumstances, it is important that the catheters bereadily visible, and accordingly, that the patient be movable with respect to the X-ray tubes. This is conveniently accomplished by the apparatus of this invention by the ready movement of the table with respect to the stable position of the axes of such X-ray tubes and image tube. The ready manipulation of table and patient with respect to the image amplifier is controlled by observation through the mirror system 46 or by a television camera 47. All parts of the patient on the table are thus quickly and clearly observable because or" the non-vibratory motion of the readily rotatable image amplifier tube 23, and the freedom of motion of the patient and table with respect to the X-ray tube shield and image amplifier, and because the table is free of wires or tubes going under or over said table.

The image amplifier is then lowered close to the patients anterior chest. The table is moved so that catheter may be within the X-ray field and observed through the mirror system or television system by the operator. When the catheter is properly positioned, radio-opaque fluids (organic iodides. 35-85% solution) may be injected (5- cc.) through the catheter, or other physiologic data such as pressureobtained through the catheter.

Precise observation during this period of injection and the following few seconds-usually 5 to 15 seconds-when the heart chambers are filled by this radio-opaque liquid, is one of the purposes of the preceding catheterization procedures. The sharpest possible images and pictures are needed to provide the most complete and accurate representation of the conditions demonstrable by this technique. In observing malformations, as through the mirror system '46 of the image amplifier, movement of the image amplifier to the most effective position must not be accomplished at the cost of blurring of the picture image (or moving picture or TV image) due to oscillations of the screen or image amplifier, nor limited by the mechanical presence or" supports for the X-ray apparatus.

Further, during this period, the sharpness of picture image obtained by parallel X-ray beams is especially inportant. Further still, while this brief optimum diagnostic period lasts, rapid and convenient motion of the patient, without his bodily movement, to a position over an X-ray film and exposure in such position to a long distance (about 4 to 6 feet) X-ray source, as 56', is extremely desirable and is permitted by the assembly according to this invention. As shown in FIGURE 6 the patient 17 on table 21 is thus conveniently and readily positioned over an X-ray film cassette or roll film changer 129. This invention also permits the image amplifier to be readily moved so that its longitudinal axis is horizontal. In this position the second X-ray tube 5t may be readily moved to the position of FlGURE 2, for a lateral X-ray view of the patient. According to my invention, these procedures are greatly facilitated to such a degree as to make practical the short time available for such studies and diagnoses.

It will be noted that by this arrangement the table 21 may be rolled over various film changers after the catheters had been positioned in the body of the patient and while the electronic instruments are still connected to the table and the patient.

The ease of operation, which facilitates and expedites cardiac diagnostic procedures, gives a greater margin of safet to the patient than heretofore possible. Even the smallest baby is visible at all times. With a television camera incorporated into the assembly, two or more op: erators may manipulate cardiac catheters from any position around the table simultaneously. Clamp-on instrument holders, trays, and tables are easily attached and moved for any desired procedure. Fluids are kept out of the electronic connections and plungs are protected both inside and outside the table as shown in FIGURE 9.

A second table may be provided so that setting, sterilization of instruments, or even the early portions of the procedure may be performed in another room. The table would simply be plugged into the conduit 137 when brought into the main room. The two tables may be different in size to facilitate operations upon babies. Diagnostic procedures on infants are usually somewhat more complex, and a small operating table in such instances would allow even more maneuverability about the equipment and the patient.

By addition of a second X-ray control panel and power supply, simultaneous lateral angiography and antero-posterior cineangiography may be done.

The above described apparatus may also be used in combination with a second image intensifier, so biplane cineangiocardiography may be done. The second image intensifier would be installed in a fixed horizontal longitudinal axis perpendicular. to the vertical axis of the first one described, movable in a vertical plane so that during routine antero-posterior examinations it could be lifted to the ceiling and out of the way. The face of this second image intensifier would be in a plane parallel to the longitudinal axis of the operating table, and directed at the second X-ray tube (59) used for lateral examinations. This second tube would not require a tilting mechanism; when both image intensifier sets are installed at the same time, the antero-posterior image intensifier would not necessarily need a tilting mechanism.

The second image intensifier would be supported from above its center of gravity in the position shown as 193 in FIGURE 7, with its longitudinal axis in the plane in which the cylinder -2 rotates about the pin 54: the axis of said second image intensifier would be directed towards X-ray tube 59.

The conduit 137 serves to connect the instruments attached to plugs 135 in side and end panels as 132, 133, 134 to effect electrical connection of such instruments across the table 21. This table may be readily locked in position or freely movable about room 1%7 without crossing or obstructing the top or bottom surface of said table b instrument wires and so permits relative motion between collimating shield 19 and the table 21-while said collimating shield is in close approximation to the bottom of the patient-supporting surface (12%) of said table-substantially over the entire working area of said table while using instruments where wires would otherwise obstruct the diagnosis and operating field: this conduit also provides connection from such instruments to recording instruments, as 194, 195, 196 in the diagnosis and operating room 197 whereby such instruments, also, are available for use yet out of the way of the operator. Such conduit further provides connection from the table to X-ray and hydraulic power control elements located, as 65, also out of the way of the operator.

According to this invention I have provided an X-ray apparatus assembly for use in diagnosis and operation which assembly comprises a first X-ray tube 15, supported by the framework of a building in a well in the floor of said building and positioned to emanate X-rays mainly along a vertical axis, through a collimating shield 19 (lead-lined to absorb the more non-linear of the X rays) extending upwards a substantial distance from said X-ray tube, a movable table 21 for support of the patient, which table provides a support surface for the patient which (support) is substantially transparent to X-r-ays, and said collimating shield extends substantially up to said support surface, a means, as 22 or 23, selectively sensitive to X-rays and supported in a carrier above X-ray tube 15 and table 21 positioned so as to be in alignment with said first X-ray tube along said first vertical axis (center of tube 19), and a second X-ray tube 56} firmly supported from the building frame on a pivotally mounted extensible hydraulic piston for motion in only one vertical plane, said one vertical plane including said first vertical axis: thereby the expensive image amplifier, television camera and associated equipment need not be duplicated for use in two positions. Space is provided, as at 198 and 197, for additional electrical and camera equipment as needed. The carrier for said X-ray sensitive means is not only firmly positioned and supported from the framework of the building and so provides maximum space for the operator without interference by such supports while providing excellent image clarity and avoiding misalignment and relative motion between X- ray tube and X-ray sensitive means, but also said carrier is readily rotatable about the afore-mentioned first vertical axis. Said carriage, further, permits said X-ray sensitive means to be controllably tilted, as shown in FIGURES 2 and 5, to to said first vertical axis. This cooperation of building frame structure and X-ray components and sup-ports in a room arranged as 197 above described, as well as the features or" the above described components expedite and facilitate X-ray diagnostic and operational procedures, especially cardiac catheterization procedures, in a manner and to a degree heretofore unavailable.

While the forms of the apparatus herein described constitute preferred embodiments of the invention, it is to be understood that the invention is not limited to these precise forms of apparatus, and that changes may be made therein without departing from the scope of the invention which is defined in the appended claims.

I claim:

1. An X-ray examination apparatus in an X-ray examination room and comprising a fixed X-ray tube, fixed in the fioor of haid room and directed upwardly, a means selectively sensitive to X-rays in alignment with said tube along a vertical axis and located at a distance from said tube such that rays emanating from said tube reach said X-ray sensitive means in substantially parallel lines and firmly supported for movement along and about said axis from a fixed point in the ceiling of said room.

2. In an X-ray examination room, said room being supported within a building framework, a diagnostic and operation assembly comprising a fixed X-ray tube firmly supported on the framework of said building in the floor of said room and directed upwardly, and a means selectively sensitive to X-rays in alignment therewith along a vertical axis and located at a distance from said tube such that rays emanating from said tube reach said X-ray sensitive means in substantially parallel lines, a carrier for said X-ray sensitive means which carrier is firmly supported through auxiliary power means from the framework of said building in the ceiling of said room and is movable only along and rotatably about said axis and supports said X-ray sensitive means from a fixed point in the ceiling of said room.

3. An assembly as in claim 2 where the X-ray sensitive means is an X-ray film.

4. An assembly as in claim 2 where the X-ray sensitive means is an image amplifier.

5. An assembly as in claim 2 wherein the X-ray assembly means is a fluoroscope screen.

6. In an X-ray examination room, said room being supported within a building framework, a diagnostic and operational assembly comprising a fixed X-ray tube positioned in a well firmly supported on the framework of said building in the floor of said room and directed up wardly and a means selectively sensitive to X-rays in align ment therewith along a vertical axis and located at a distance from said tube such that rays emanating from said tube reach said X-ray sensitive means in substantially parallel lines, a carrier for said X-ray sensitive means, which carrier is firmly supported, through auxiliary power means, from the framework of said building in the ceiling of said room and is movable only along and rotatably about said axis from a fixed point in the ceiling of said room, a movable table above said X-ray tube, said table comprising a horizontal weight-supporting surface substantially transparent to X-r-ays, a collimating shield extending upward from said X-ray tube to the bottom of said surface of said table, said table being freely movable in a horizontal plane normal to said axis, the bot- 1 i 1 2 tom surface of said table being clear of any obstruction References Cited in the file of this patent to the movement o: f said shield relative to sai i tabie. UNETED STATES PATENTS 7. Apparatus as in claim 6 wherein the auxiliary power means is firmly connected to said framework and said 113841144 Meyer July 1921 carrier is slidably yet controliably supported thereby and 5 2,125,586 P0111 2, 1938 said carrier supports the X-ray sensitive means, and 2,276,137 ung Man 1 1942 which auxiliary power means controllably moves and posi- ,663,912 Goldfield et a1 Feb. 9, 1954 tions said X-ray sensitive means along said axis. 2,997,585 Schiring Aug. 22, 1961 

1. AN X-RAY EXAMINATION APPARATUS IN AN X-RAY EXAMINATION ROOM AND COMPRISING A FIXED X-RAY TUBE, FIXED IN THE FLOOR OF HAID ROOM AND DIRECTED UPWARDLY, A MEANS SELECTIVELY SENSITIVE TO X-RAYS IN ALIGNMENT WITH SAID TUBE ALONG A VERTICAL AXIS AND LOCATED AT A DISTANCE FROM SAID TUBE SUCH THAT RAYS EMANATING FROM SAID TUBE REACH SAID X-RAY SENSITIVE MEANS IN SUBSTANTIALLY PARALLEL LINES AND FIRMLY SUPPORTED FOR MOVEMENT ALONG AND ABOUT SAID AXIS FROM A FIXED POINT IN THE CEILING OF SAID ROOM. 